The predictive value of stress hyperglycemia on thrombus burden in nondiabetic patients with ST-segment elevation myocardial infarction

Sığırcı, Serhat; Yıldız, Süleyman Sezai; Keskin, Kudret; Çetinkal, Gökhan; Aksan, Gökhan; Gürdal, Ahmet; Çetin, Şükrü; Kılcı, Hakan; Kılıçkesmez, Kadriye Orta

doi:10.1097/mbc.0000000000000832

Cited by 14 publications

(17 citation statements)

References 30 publications

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“…Insulin resistance and glycaemic disorders, characterized by hyperglycaemia with hyperinsulinaemia or normoglycaemia, induce various pathophysiological abnormalities and are therefore accompanied by several cardiovascular and metabolic risk factors and comorbidities. Previous studies have found that patients with higher insulin resistance might have more pronounced concentric cardiac remodelling and a higher incidence of arterial stiffness [ 43 ]. However, the potential pathologic mechanisms that determine these correlations have still not been completely clarified [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Triglyceride glucose index combined with plaque characteristics as a novel biomarker for cardiovascular outcomes after percutaneous coronary intervention in ST-elevated myocardial infarction patients: an intravascular optical coherence tomography study

Zhao

Wang

Chen

et al. 2021

Cardiovasc Diabetol

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Background and aim This prospective study explored plaque morphology according to the underlying culprit lesion pathology (rupture versus erosion) in relation to the triglyceride glucose (TyG) index in patients with acute ST-elevated myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention and optical coherence tomography (OCT) for culprit lesions to elucidate the effects of the TyG index and type of plaque on the incidence of major adverse cardiovascular events (MACEs). Methods and outcomes A total of 274 patients with STEMI aged ≥ 18 years who underwent pre-intervention OCT imaging of culprit lesions between March 2017 and March 2019 were enrolled. The TyG index was calculated using the formula ln[fasting TG (mg/dL) × fasting glucose (mg/dL)/2]. Patients with plaque rupture (PR) and plaque erosion (PE) were divided into three groups across the TyG tertiles. MACEs were defined as a composite of all-cause death, myocardial infarction (MI) recurrence, and ischaemic stroke. In fully adjusted analyses, the middle tertile of TyG was significantly associated with greater rates of MACEs in patients with PR but not in those with PE (relative to the low tertile, HR [hazard ratio], 6.01; 95% confidence interval [CI], 1.25–28.88; P = 0.025). Cox regression models indicated a significantly higher HR for MACEs in patients in the middle tertile of TyG than in those in the low tertile of TyG after full additional adjustment (HR, 5.45; 95% CI, 1.10–27.09; P = 0.038). However, being in the high tertile of TyG independently and significantly increased the risk of major bleeding events among patients with PE (HR, 2.50; 95% CI, 1.11–5.65; P = 0.028). The area under the receiver operating characteristic curve for predicting MACEs to evaluate the diagnostic value of the TyG index combined with the morphological characteristics of plaque after full adjustment was 0.881 (sensitivity = 94.74%, specificity = 78.04%, cut-off level = 0.73). Kaplan–Meier curves were generated for the cumulative incidence of MACEs for up to a median of 1.98 years stratified by tertiles of TyG among the PR and PE subgroups. Among patients with PR, there were significant differences among the tertiles of TyG (p = 0.030). Conclusion and relevance Microstructural OCT features of culprit lesions in combination with the TyG index, a surrogate estimate of insulin resistance, can be used in clinical practice to support risk stratification and predict adverse events in patients with STEMI.

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Section: Discussionmentioning

confidence: 99%

Triglyceride glucose index combined with plaque characteristics as a novel biomarker for cardiovascular outcomes after percutaneous coronary intervention in ST-elevated myocardial infarction patients: an intravascular optical coherence tomography study

Zhao

Wang

Chen

et al. 2021

Cardiovasc Diabetol

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“…Admission hyperglycemia in STEMI patients might play a role in coronary thrombosis through altering clot features and enhancing local thrombin generation and platelet activation [23]. It is associated with the large thrombus burden which causes adverse cardiac outcomes [24]. There were no relationships of ARPG to thrombus length and type in the present study which might due to that the thrombus overlying the lesion might have been dissolved before OCT imaging [11].…”

Section: Discussionmentioning

confidence: 67%

The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction

Liu

Wang

Cui

et al. 2020

Cardiovasc Diabetol

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Background: Plaque rupture (PR) and plaque erosion (PE) are main causes of acute myocardial infarction with different demographic and histology characteristics and need different treatment strategy. PR and PE can be identified with optical coherence tomography (OCT) accurately, but convenient and effective noninvasive markers for them are rarely found. History of diabetes mellitus (DM) was reported to be a potential predictor of PR in ST-segment elevated myocardial infarction (STEMI) patients, but the predictive value of other glucose-related variables for it is still uncertain. Present study aimed to clear the relationship between some glucose-related variables and plaque morphology in patients with STEMI. Methods: We consecutively enrolled 872 STEMI patients and divided them into PR group (n = 616) and PE group (n = 256) based on OCT diagnostic criteria. The relationship of glucose-related variables, including random plasma glucose on admission (ARPG), glycosylated hemoglobin (HbA1c), post-PCI fasting plasma glucose (PFPG), DM history, glucose variable tendency (GVT) and the acute-to-chronic glycemic ratio (A/C), to the PR risk of STEMI patients was analyzed. The correlation between the glucose-related variables and plaque morphology was analyzed meanwhile. Results: Among the glucose-related variables, ARPG and GVT were confirmed to be independent predictors for PR after adjusting for other traditional risk factors in nondiabetic patients. The higher the ARPG level, the more PR risk the STEMI patients had. And high HbA1c and APPG were demonstrated to have a weak and positive correlation with lipid constituents and stenosis degree of culprit vessel. Conclusions: Compared to HbA1c, DM history, and some other glucose-related variables, ARPG and GVT were risk factors for PR in STEMI patients, especially those without DM. And high HbA1c and ARPG were positively correlated with the development of vulnerable plaque in culprit vessels. Trial registration Present study is a retrospective one and the population came from the EROSION study of our center previously. It was approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University (Approval reference number, KY2017-249), and all patients provided written informed consent prior to the inclusion in the study and the investigation conformed to the principles outlined in the Declaration of Helsinki.

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“…In line with this result, the present study revealed that culprit vessels with LTB were more frequently encountered in the RCA in diabetic patients with STEMI. In a very recent study, Sigirci et al (9) suggested that stress hyperglycemia, defined as admission blood glucose level, is an independent predictive factor of LTB in nondiabetic patients with STEMI. However, the underlying impact of stress hyperglycemia on intracoronary thrombus burden in STEMI patients with DM is still unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the stress hyperglycemia ratio (SHR), which is calculated by combining acute (admission glucose level) and chronic [estimated by glycosylated hemoglobin (HbA1c)] glycemic value, was proposed as a novel index of stress hyperglycemia and had a better prognostic value in AMI patients with DM (6)(7)(8). Besides, a recent study has reported that admission hyperglycemia is associated with large thrombus burden (LTB) in nondiabetic patients with STEMI (9). However, the association between stress hyperglycemia and intracoronary thrombus burden in diabetic patients has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Association of stress hyperglycemia ratio with intracoronary thrombus burden in diabetic patients with ST-segment elevation myocardial infarction

Chu¹,

Tang²,

Liu³

et al. 2020

J Thorac Dis

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Background: Large intracoronary thrombus burden is not rare during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Stress hyperglycemia is independently associated with poor prognosis. However, the underlying relationship between stress hyperglycemia and thrombus burden remains unknown. This study aims to investigate the association of stress hyperglycemia, evaluated by the combination of acute and chronic glycemic levels, with intracoronary thrombus burden in diabetic patients with STEMI. Methods: We enrolled 227 consecutive diabetic patients with STEMI undergoing primary PCI within 12 hours after symptom onset. Stress hyperglycemia was estimated using the stress hyperglycemia ratio (SHR), which was calculated as admission glycemia divided by estimated average glucose derived from glycosylated hemoglobin. Based on reclassified angiographic thrombolysis in myocardial infarction (TIMI) thrombus grades, patients were divided into small thrombus burden (STB) group (TIMI thrombus grades <4) and large thrombus burden (LTB) group (TIMI thrombus grades 4 or 5). Results: Of the entire study population, 77 (33.9%) patients were categorized as LTB group, whereas 150 (66.1%) patients presented with STB. The mean age was 64.1 years, and 80.6% of the patients were male. The SHR levels were significantly higher in patients with LTB than in those with STB [1.31; interquartile range (IQR): 1.13-1.48 versus 1.11; IQR: 0.96-1.32; P<0.001]. The predictive performance of SHR for LTB was moderate (area under the curve: 0.669; 95% confidence interval: 0.604-0.730; P<0.001), with the best cut-off value 1.19 (sensitivity 71.4%, specificity 64.7%). The incidence of LTB with SHR ≥1.19 was significantly higher compared with SHR <1.19 (50.9% versus 18.5%; P<0.001). Based on the multivariable logistic regression analysis, the high SHR (≥1.19) was found to be an independent predictor of LTB following adjustment for baseline clinical confounders. Conclusions: A high SHR value was independently associated with large thrombus burden and has a better predictive value than glycemia at admission in diabetic patients with STEMI undergoing primary PCI.Stress hyperglycemia may play an important role on the intracoronary thrombus formation.

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The predictive value of stress hyperglycemia on thrombus burden in nondiabetic patients with ST-segment elevation myocardial infarction

Cited by 14 publications

References 30 publications

Triglyceride glucose index combined with plaque characteristics as a novel biomarker for cardiovascular outcomes after percutaneous coronary intervention in ST-elevated myocardial infarction patients: an intravascular optical coherence tomography study

Triglyceride glucose index combined with plaque characteristics as a novel biomarker for cardiovascular outcomes after percutaneous coronary intervention in ST-elevated myocardial infarction patients: an intravascular optical coherence tomography study

The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction

Association of stress hyperglycemia ratio with intracoronary thrombus burden in diabetic patients with ST-segment elevation myocardial infarction

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